Our drug policy system is an expensive failure. What are the alternatives?

The
exorbitant cost of punitive drug policy is actually an argument for change. What
if we invested in good quality treatment for addiction instead? Español

Needle exchange programme, Portland, Maine 2012. Press Association/Robert F. Bukaty. All rights reserved.The war on drugs has been an expensive
failure, but its true price tag can only be measured when we include the
indirect costs that far exceed the $100 billion that governments spend each
year trying to control the world supply of illegal drugs. The full implications
of this wasted expenditure should factor into arguments for an urgently needed
and radical
redirection of drug policy.

Much of the $100 billion pays for
apprehending, processing and incarcerating people for non-violent drug offences.
But this figure is far outweighed by the value of the illegal drug market that
results from punitive drug wars, a figure estimated at $330 billion, a vast
source of funds for corruption and insurgency. Militarised drug disruption
programmes in central and south America and Asia have caused hundreds of
thousands of deaths, the displacement of significant numbers of people and massive
environmental degradation. The global south has also lost significant
investment opportunities in their economies and health systems as they pay to
prosecute drug wars, often under pressure from the United States.

The scale of the policy’s failure is
profound, and it is imperative that we step back from the ideology behind it. In
place of an expensive ‘war’ against producers and traffickers in illegal drugs with
front lines in low-income states, we should work to reduce problematic demand for
these drugs amongst consumers at home, including by ensuring that the small
percentage of drug users who are dependent on drugs get access to the full
range of services and support that they need. The prohibition-first approach
tramples on human rights and relegates public health to a secondary
consideration. Reversing these priorities would improve lives at both ends of
the supply chain, perhaps dramatically.
And economic benefits and their knock-on effects could also be significant.

The prohibition-first approach
tramples on human rights and relegates public health to a secondary
consideration.

The key is to follow the empirical evidence.
Most demand comes from a small number of users, so treating relatively few
people can have a disproportionately large impact. Spending on good quality
treatment for addiction can produce a many-fold return on investment: in
reduction in crime, in saved healthcare costs and earnings of people who become
productive again. Even expensive residential treatment can pay for itself.

Effective
treatment options do exist. One is opioid substitution therapy (OST) in which a
prescription opioid medication like methadone or buprenorphine helps people
manage the craving for more dangerous substances. OST, when scaled up, can contribute to reducing
overdose, the cause of 47,000 deaths in the United States in 2014, according to
the Centers for Disease Control and Prevention. OST pays for itself many times
over, partly through savings in health costs and reduction in the harms of
problematic opioid use.

Needle exchanges help to prevent incidence
of HIV and hepatitis C, both of which are expensive to treat. Needle and syringe programmes are among the
best researched interventions in all of public health. They prevent disease without encouraging new
or more frequent drug use.

But scientifically sound drug treatment and
preventive programmes like needle exchanges are not options for most of the
world’s drug users. They are not available or there are major barriers to their
use. Often this is because of a belief that the best response to drug use is a
criminal justice rather than a public health response.

Drug courts in the United States, for
example, were established, in theory, to offer an alternative to jail in the
form of court-supervised treatment for drug dependence. But in many cases
judges do not have the training to make good medical decisions, and some don’t
seem to listen to health professionals. OST is disallowed by many drug courts,
which is a missed opportunity to get people what may be the most effective
treatment possible. Some judges also punish ‘failure’ of treatment programmes
by putting people in jail, even though health professionals know that not all
people succeed the first time in addiction treatment.

We must challenge attitudes that
portray drug use as the result of a moral failing or character flaw.

We must challenge attitudes that portray
drug use as the result of a moral failing or character flaw. The US experience
suggests that many prevention programmes that preach abstinence at kids and try
to scare them away from drugs don’t have a good record, and may even make drugs
more, rather than less, appealing. Approaches based more on the reality of
kids’ lives – finding out what really motivates them to try drugs – and on helping
them to protect themselves from problematic use have a better chance of
success.

Official rhetoric is shifting slowly away
from complete prohibition. The inertia that characterises the federal
government in the United States means that progress must be sought at the state
and municipal level. One such initiative is the Law Enforcement Assisted
Diversion (LEAD) programme that began in Seattle that allows police officers to
divert low-level offenders into drug programmes or to employment assistance or
housing or social support in the community rather than jail. Albany and Santa
Fe are among other communities to adopt LEAD programmes.

Laws against marijuana use have been
relaxed in a number of states, and part of the argument in favour of state
regulation has been revenue-based. The state of Colorado raised more than $70
million from marijuana in 2014, more than it took in for alcohol sales, and
savings have accrued from averted law enforcement and incarceration on the other side of the ledger. Economic pressure
continues to grow on the existing system, and evidence-based
arguments for a change in policy should incorporate the exorbitant indirect and
direct costs of the current system, not just in the United States but in producer
and transit countries long ravaged by the disastrous consequences of the war on
drugs.

This article is published as part of an editorial partnership between openDemocracy and CELS, an Argentine human rights organisation with a broad agenda that includes advocating for drug policies respectful of human rights. The partnership coincides with the United Nations General Assembly Special Session (UNGASS) on drugs.

About the author

Joanne
Csete is an expert on health and human rights, especially access to health
services for criminalised persons and gender-related rights. She is an adjunct
associate professor at Columbia University’s Mailman School of Public Health.

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